When the bottom line is about the bottom line…

Veterinary school taught me veterinary ethics, not business ethics. I’ve never possessed a driving ambition to own my own practice. My professional goal was to earn a living doing what I love rather manage my own hospital. My vision was to be employed in a position where using my expertise in treating cancer in pets was my sole responsibility.

Veterinary medicine is a business like all other professions. Those of us working in the field need to earn a living just as much as the next person. Though we’re driven by a love of animals and a desire to help them live longer and healthier lives, we can’t do it for free. As much as we hate to talk about it, we’re acutely aware of how money plays a role in what we do and how we do it.

Operating a veterinary hospital is expensive, especially for facilities such as the ones where I work, that are open 24 hours a day, 7 days a week. As an oncologist, I expect to maintain an inventory of pricey chemotherapy drugs to use for treating my patients. I want the most experienced technicians to administer chemotherapy. I need expensive equipment such as an ultrasound, a digital x-ray machine, and a CT scanner to accurately stage my patient’s cancer. I’d like to be paid for my time. All of these desires represent overhead for my hospital, and the expenses must be justified by the revenue I’m able to produce.

In reverse, I’m expected to generate a particular amount of income each day in order to “earn my keep.” I have to financially justify my want to continue to be paid, to have the state of the art equipment, and to work with fantastic support staff. When circumstances are favorable, I’m praised for my effort and interest is placed on discerning the “how’s and why’s” of the success so we can expand the benefit further.

When I miss the mark, I’m accountable for explaining my shortages and the emphasis is on the “how’s and why’s” of the deficit and how to reverse the situation. In the toughest of times, this could mean I’ll suffer a decrease in my own compensation or even termination of my services.

There’s a problem with making matters of veterinary care and money so business-like. When success is measured financially, veterinarians are expected to see more and more patients in a day, to increase availability beyond ‘typical’ working hours, and to constantly market themselves to the public and other veterinarians. They therefore work longer days, have fewer days off, and are constantly accessibile via email or social media.

These aren’t necessarily bad characteristics of a doctor. It’s important that I’m accessible to my owners and I want them to be able to trust my judgement in taking care of their pets. I want to see as many cancer cases as possible. It’s the best means I have to educate people against the myths and misconceptions about treating cancer in pets. I want to accomplish these goals with compassion and intelligence, and be thought of as the doctor who makes owners feel as though their pet is the only patient I’m responsible for.

The danger is when throughput is accelerated, doctors hit a point of diminishing returns. In the most extreme cases, patience expires, capabilities are stretched, attention is diverted, and mistakes happen. There comes a point where they may be able to see more cases but they won’t be producing more revenue. Compassion fatigue weighs them down with the greatest of pressure. Concurrently, pet owners will feel rushed and less connected with their veterinarians. They will lose trust and be unwilling to pursue recommendations. This means they’re spending less money in the long run.

I’ve worked in several geographical regions of the US, in hospitals of different sizes, and with varying degrees of staff expertise and capabilities, yet the message has always been the same. The “bottom line” is often the driving factor for any decision made regarding how I’m expected to practice and what I’m expected to produce. I’ve talked with colleagues spread among a wide geographical range who share similar frustrations. The pressure of performing financially as a veterinarian is not unique to any one particular practice type or specialty or location.

I urge those of you considering veterinary medicine as your career to think about how much you will mind manners of money beyond the expected discussions you will have with pet owners. Depending on where you work, your job security might depend more on your ability to generate revenue rather than your knowledge or your bedside manner.